Citalopram important information

Citalopram is a prescription medication classified as a selective serotonin reuptake inhibitor (SSRI). It is commonly prescribed to treat major depressive disorder (depression) and may be used for other conditions as determined by a licensed healthcare provider. As with all prescription medications, citalopram may not be appropriate for everyone. For full prescribing information, view the drug label information.

Before using citalopram, what should I tell my doctor?

All medical conditions you have or have had, especially:

• • Bipolar disorder or a history of mania/hypomania
  • Seizures or epilepsy
  • Liver disease (citalopram is processed by the liver; dose adjustments may be needed)
  • Heart rhythm problems, including long QT syndrome, prior fainting, or known arrhythmias
  • Low potassium or low magnesium (electrolyte abnormalities can increase arrhythmia risk)
  • Low sodium (hyponatremia), especially in older adults or if you take diuretics (“water pills”)
  • Bleeding problems or easy bruising
  • Glaucoma, especially narrow-angle glaucoma
• All medications you are currently taking or plan to take, including:
• • Prescription medications
  • Vitamins, supplements, and herbal products (especially St. John’s wort)
  • Other medications that increase serotonin (risk of serotonin syndrome)
  • Blood thinners or medications that increase bleeding risk (e.g., warfarin, aspirin, NSAIDs like ibuprofen/naproxen)
  • Medications that can affect heart rhythm (QT-prolonging drugs)
• Any allergies or prior adverse reactions to citalopram, escitalopram, or other SSRIs
• Pregnancy and breastfeeding status
• • Tell your provider if you are pregnant, planning pregnancy, or breastfeeding.
• Alcohol or recreational drug use
• Any history of suicidal thoughts, self-harm, worsening depression, severe anxiety/agitation, or significant mood changes.

What are some of the side effects of this drug?

Some side effects are common and often mild, especially when starting citalopram or changing the dose. These may include:

• Nausea or upset stomach
• Diarrhea or constipation
• Dry mouth
• Headache
• Dizziness
• Fatigue or drowsiness
• Trouble sleeping (insomnia) or sleepiness
• Increased sweating
• Sexual side effects (e.g., decreased libido, delayed ejaculation, difficulty achieving orgasm)
• Appetite or weight changes
• Tremor or feeling jittery/restless

Many side effects improve as your body adjusts. If side effects persist, become severe, or interfere with daily functioning, contact your healthcare provider.

What are side effects I should call my doctor about right away?

Seek urgent medical attention or contact your healthcare provider right away if you experience:

• Suicidal thoughts or behaviors, or new/worsening depression
• New or worsening anxiety, agitation, panic, irritability, aggression, or impulsivity
• Mania/hypomania symptoms, such as:
• • Unusually elevated or irritable mood
  • Decreased need for sleep
  • Racing thoughts, risky behavior, or unusually increased activity/talking
• Severe allergic reactions, such as:
• • Rash or hives
  • Swelling of the face, lips, tongue, or throat
  • Difficulty breathing
• Seizures
• Abnormal bleeding or bruising, black/tarry stools, coughing/vomiting blood
• Severe headache, vision changes, or eye pain
• Severe dizziness or fainting, chest pain, or irregular heartbeat
• Symptoms of low sodium, such as headache, confusion, weakness, severe fatigue, unsteadiness, or seizures
• Serotonin syndrome symptoms, such as:

• • Fever, sweating, shivering
  • Confusion, agitation
  • Rapid heart rate, blood pressure changes
  • Diarrhea
  • Muscle stiffness, twitching, tremor, loss of coordination

• Heart rhythm symptoms, such as:
• • Palpitations or a racing/irregular heartbeat
  • Fainting
  • Severe dizziness

These symptoms may indicate serious or life-threatening reactions and require prompt evaluation.

Important safety information

• Heart rhythm (QT prolongation): Citalopram is associated with dose-dependent QT prolongation, which can lead to serious arrhythmias in susceptible individuals. Your provider may avoid higher doses or recommend monitoring if you have risk factors.
• Do not stop abruptly: Stopping citalopram suddenly may cause discontinuation symptoms (e.g., dizziness, nausea, irritability, insomnia, “electric shock” sensations). Tapering should be supervised by a clinician.
• Drug interactions: Citalopram can interact with other medications and supplements, including those that affect serotonin or prolong the QT interval.
• Alcohol and impairment: Alcohol may worsen side effects. Use caution with driving or hazardous activities until you know how citalopram affects you.
• Suicidality risk: Antidepressants may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly early in treatment or after dose changes. Monitoring is important.
• Electrolytes matter: Low potassium or magnesium can increase arrhythmia risk. Tell your provider if you have vomiting/diarrhea, dehydration, or take diuretics.

Do not take citalopram if you

• Are allergic to citalopram or any ingredient in the medication
• Are taking (or have taken within the last 14 days) a monoamine oxidase inhibitor (MAOI)
• Are taking linezolid or intravenous methylene blue, unless specifically directed and monitored by a clinician (risk of serotonin syndrome)
• Are taking pimozide (risk of serious heart rhythm problems)
• Have been told by a licensed healthcare professional that you should not take SSRIs

L-methylfolate important information

Before starting L-methylfolate, tell your healthcare provider all relevant medical information, including:

• All medical conditions you have or have had, especially:
• • Bipolar disorder, history of mania or hypomania
  • Seizure disorders
  • Pernicious anemia or known vitamin B12 deficiency (folate supplementation can improve anemia labs while underlying B12 deficiency may worsen neurologic injury if not treated)
  • Kidney disease (especially if you are on dialysis) or significant chronic illness
  • Any history of cancer, particularly if you have been told to avoid folate supplementation (follow oncology guidance)
• All medications and supplements you take, including:
• • Other folate-containing supplements or multivitamins
  • Medications that may interact with folate metabolism (your clinician will assess relevance), such as certain antiseizure medications
  • Any medications for mood disorders, including antidepressants and mood stabilizers
• Any allergies or prior adverse reactions to folate products or ingredients in the formulation
• Tell your provider if you have had suicidal thoughts, significant mood instability, or a history of manic symptoms.
• If you are pregnant, planning to become pregnant, or breastfeeding
• • Folate is often used in pregnancy, but dosing and indication should still be reviewed with your clinician, particularly for prescription-strength products.

What are some of the side effects of this drug?

Contact your healthcare provider right away or seek urgent care if you experience:

• Symptoms of a serious allergic reaction, such as:
• • Hives or widespread rash
  • Swelling of the face, lips, tongue, or throat
  • Trouble breathing
• New or worsening mood symptoms, such as:
• • Severe agitation, restlessness, or anxiety
  • Symptoms of mania/hypomania (e.g., unusually elevated or irritable mood, decreased need for sleep, racing thoughts, impulsive/risky behavior)
• Neurologic symptoms that could suggest untreated vitamin B12 deficiency, especially if you have risk factors:
• • New numbness/tingling in hands or feet
  • New balance problems or difficulty walking
  • New confusion or memory changes
 (These symptoms are not specific to L-methylfolate but warrant evaluation.)

What are some of the side effects of this drug?

• Vitamin B12 considerations: In certain individuals, folate supplementation may improve anemia-related lab values while vitamin B12 deficiency remains untreated, which can allow neurologic injury to progress. Your provider may recommend checking B12 levels if clinically indicated.
• Medication and supplement overlap: Many multivitamins and supplements contain folate. Taking multiple folate-containing products may result in higher total intake than intended.
• Not a substitute for prescribed treatment: L-methylfolate should be used only as directed and should not replace other treatments recommended by your clinician.
• Mood activation risk: In people with bipolar disorder or a history of mania/hypomania, L-methylfolate may contribute to mood activation in some cases. Inform your provider of any bipolar history and report significant mood changes promptly.

Do not take L-methylfolate if you

• Are allergic to L-methylfolate or any ingredient in the formulation
• Have been instructed by a licensed healthcare professional to avoid folate supplementation
• Have a known or suspected untreated vitamin B12 deficiency and have been told to address B12 first (follow your clinician’s guidance)

Important Notice


 This content is for general informational purposes and does not replace medical advice. Always follow the guidance of your licensed healthcare provider. If you believe you are experiencing a medical emergency, call 911 or your local emergency number immediately.